Longevity: what to eat to preserve muscle and bone

What is longevity, and why is it not the same as living for many years?

Living for many years is a number; the longevity that matters is how many of those years you spend living your life. The World Health Organization defines healthy ageing as “the process of developing and maintaining the functional ability that enables wellbeing in older age” [3]. See “Foods for memory”.

That functional ability has five concrete components, according to the WHO [3]: meeting basic needs, learning and making decisions, moving, maintaining relationships and contributing to others. Notice which of these depends directly on what you eat and how you train.

That is why this guide is not about extending life. It is about reaching eighty able to stand up from a chair without using your hands, carry the shopping and go outside without fear of falling. It is an easy goal to state and a hard one to sell. But it is the one supported by evidence and worked on from the plate.

And it has a practical consequence: what is protected is not weight but muscle and bone. A stable number on the scales may hide simultaneous muscle loss and fat gain.

Is there a diet that extends life?

A specific diet that extends life? No. An eating pattern supported by a large trial? Yes, and it is eaten here. It is the Mediterranean pattern, and the strongest study supporting it was carried out in Spain in people aged 55 to 80.

The PREDIMED trial compared two versions of the Mediterranean diet, one with extra-virgin olive oil and the other with nuts, against a low-fat diet. The participants were people at high cardiovascular risk. Both Mediterranean groups had around 30% fewer heart attacks, strokes and cardiovascular deaths than the low-fat group [4].

Three points change how that figure should be read.

• These were people at high cardiovascular risk, not a healthy general population. The absolute benefit is smaller in someone without that risk.
• It measured heart attacks and strokes, not years of life. Fewer cardiovascular events is excellent news, but it is not the same as “you will live longer”.
• The authors withdrew the 2013 publication and rewrote it in 2018 after finding problems in how some participants had been assigned. The figures given here are from the corrected version [4].

Vegetables, pulses, fruit, fish, nuts and extra-virgin olive oil as the main fat are the best documented option we have, and they are already cooked in most homes here. If you also want to reduce chronic inflammation, the pattern overlaps almost entirely with the anti-inflammatory diet.

What is sarcopenia, and why does it determine how you age?

Sarcopenia is the loss of strength and muscle mass that comes with the years. According to the European sarcopenia consensus, it is associated with more falls, fractures, loss of autonomy and mortality [5]. It is a word heard more and more, and almost nobody explains it through food.

When they revised that consensus in 2019, geriatricians put strength first, ahead of muscle quantity. Strength predicts what will happen to a person better than mass does [5]. Having biceps matters less than being able to do things.

That is why the questions a professional asks when suspecting sarcopenia are about daily life [5]. Whether lifting things or walking is hard, whether standing up from a chair is hard, whether climbing stairs has become a problem and whether you have fallen. The objective measurement is taken by your doctor or healthcare team, using their cut-offs. They are hand-grip strength and the time it takes you to stand up from a chair five times, and they are not for diagnosing yourself with a stopwatch.

What is in your hands are the two levers that move it: eat enough protein and do strength exercise to preserve muscle. Without the second, the first only goes halfway. Muscle and bone are lost together and are looked after with the same two things. That is why the osteoporosis diet and this guide are best read together.

How much protein should you eat after 60?

At least one gram of protein per kilogram of body weight per day, according to the European guideline on nutrition in geriatrics [1]. For someone weighing 65 kilos, that is about 65 grams of protein a day, not 65 grams of food. It can be covered, for example, with an egg, a yoghurt, a glass of milk, a serving of pulses and one of fish spread across the day, plus what bread and cereals provide.

A group of European experts who studied this question in depth is a little more specific for healthy people over 65. They propose 1.0 to 1.2 grams per kilo per day, and 1.2 or more if you also exercise [6]. The two recommendations point in the same direction and both exceed what is advised for a young adult. With age, the body uses the protein it receives less efficiently.

The same guideline reminds us of the other side, which is the one most often forgotten. If you eat too little overall, the body burns the protein you give it as energy. Its reference value is around 30 kilocalories per kilo of body weight per day, adjustable to each person [1]. In other words, an older person who eats very little has, first of all, a problem of eating too little.

If the usual food does not get you there, add protein to what you already eat. A chopped egg in the cream soup, fresh cheese in the mash, pulses in the soup or a yoghurt for dessert change the day’s total without cooking more. See “Diet and Alzheimer’s”.

And one exception that needs saying out loud. If you have kidney disease, this general protein guidance may not be appropriate [6]. Your nephrologist or dietitian-nutritionist will tell you how much protein, potassium, phosphorus and other minerals suit you according to the stage of the disease.

How do you care for bones through food?

With calcium every day, whatever vitamin D you can make, the same protein that protects muscle, and exercise that loads the bone. All at once; none of these pieces works on its own.

Dietary calcium comes mainly from dairy. That is why, when someone has stopped drinking milk because it “feels heavy”, they usually need a plan and not a tip. Outside dairy there are small fish eaten with their bones, pulses, nuts and leafy vegetables. There are also plant drinks fortified with calcium; the best is soy or one with at least 3% protein, and soy is an allergen.

Most vitamin D is made by the skin from sunlight, and very little comes from food. With age, the skin makes it less well. If a supplement is needed, it is decided with a blood test and prescribed by a professional. It is not a bottle to buy just in case.

The part almost nobody associates with bone is exercise. Weight-bearing exercise helps preserve bone, just like muscle. The WHO asks people over 65 to do activity that works balance and strength on three or more days a week, to maintain functional ability and prevent falls [2]. A fall is what breaks bone, so looking after balance is looking after the skeleton.

If you already have a diagnosis of osteoporosis or have been told your bone density is low, carry on with the osteoporosis diet. And if you are going through menopause, when bone loss accelerates, we have a specific consultation in menopause nutrition.

How to spread protein across a day

Protein at all three meals and vegetables at two. There is no need to weigh or count anything; no meal should be just coffee and biscuits.

• Breakfast. A dairy product, bread with cheese, egg, or oil and tomato, and a piece of fruit.
• Lunch. Half a plate of vegetables, a quarter of protein (fish, egg, pulses or white meat) and a quarter of grain or potato, with extra-virgin olive oil.
• Dinner. The same structure, lighter. A vegetable cream soup with an omelette, baked fish with sweet potato, or lentils with rice.
• Between meals, if needed. Fruit, a handful of nuts, a yoghurt or a little cheese. Eating five times is not compulsory; reaching the day’s protein is.

Hydration also counts. With age thirst gives less warning, so it helps to drink at set times: when you get up, with each meal and mid-afternoon. Water, broth, infusions, milk and fruit all count.

If cooking has become an uphill task, the order of priorities changes. Cook more and freeze in portions, and buy tinned pulses and frozen vegetables. An egg, a tin of sardines and a yoghurt make a perfectly decent dinner.

Do fasting and anti-ageing supplements help?

Fasting is not a fast track to longevity. Neither are supplements advertised as “anti-ageing”.

Intermittent fasting and very-low-calorie diets. In general, intermittent fasting is neither recommended nor prohibited. Its effect on weight is small and similar to that of other diets with the same deficit. It should not be done by anyone under 18, pregnant women, women who are breastfeeding, or people with an eating disorder or diabetes treated with medication. In older people, the priority is to eat enough [1]. Long fasts can make that harder. At Alimmenta we do not recommend diets of less than 1,200 kcal a day. Eating below that figure requires medical supervision and can cause deficiencies. If it is decided to lose weight in old age, it is best done slowly, with at least one gram of protein per kilo and always with exercise to avoid losing muscle [1]. Losing weight at seventy is not like losing weight at forty. If this is your situation, start with the general weight-loss diet guide and discuss it first with your doctor or a dietitian-nutritionist.

Supplements. At Alimmenta we do not recommend “anti-ageing” formulas or products that promise muscle without training. A supplement is only considered if there is enough evidence and your doctor or dietitian-nutritionist prescribes it. It does not replace adequate nutrition or exercise.

And the vocabulary. “Anti-ageing”, “rejuvenation” and “reversing age” describe a business, not a biological process we know how to control. What we do know is how to slow muscle and bone loss, and that is already a lot.

What mistakes do we see in consultations?

• Celebrating that the weight is not moving while the stairs get harder. The scales do not see the muscle being lost.
• Having a glass of milk with biscuits, or broth with bread, for dinner because cooking is a struggle. It is the meal that leaves the most protein behind.
• Buying an anti-ageing supplement before looking at what is on the plate.
• Walking slowly for half an hour and counting it as strength training. Walking is good, but muscle needs some effort.
• Giving up meat because it is hard to chew and settling for purées without protein.
• Waiting until you are thirsty to drink, especially in summer.
• Looking after a father or mother with a weight-loss menu when what they need is to eat more.

We hear them every week, and none of them is anyone’s fault. Almost all of them start to be fixed by changing one meal.

Can you regain muscle at 75?

Yes. Muscle responds to training and to food at any age. It is what is said least and what changes things most.

The combination is always the same: eat enough, reach your protein target and do strength training. The geriatric guidelines repeat it even when weight loss is being considered, because without exercise muscle is lost [1]. And the strength and balance recommendations for people over 65 have no upper age limit [2].

Starting late is still worthwhile, and you do not need a gym. Sitting down and standing up from a chair, climbing stairs, carrying the shopping or working with resistance bands all work. What counts is doing it regularly and with some effort.

If you have lost weight without trying and need to regain it while building muscle and not just fat, we work on it in the weight gain consultation. Before that, read the block below, because unintended weight loss is checked first by a doctor.